Journal of Rehabilitation Research & Development (JRRD)

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Volume 49 Number 9, 2012
   Pages 1305 — 1320

Abstract — For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement

Robert L. Ruff, MD, PhD;1–3* Ronald G. Riechers II, MD;1–3 Xiao-Feng Wang, PhD;4 Traci Piero, NPC, MSN;2 Suzanne S. Ruff, PhD3,5

1Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (CVAMC), Cleveland, OH; 2Department of Neurology, Case Western Reserve University, Cleveland, OH; 3Polytrauma System of Care, CVAMC, Cleveland, OH; 4Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH; 5Psychology Service, CVAMC, Cleveland, OH

Abstract–This was an observational study of a cohort of 63 Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury (mTBI) associated with an explosion. They had headaches, residual neurological deficits (NDs) on neurological examination, and posttraumatic stress disorder (PTSD) and were seen on average 2.5 years after their last mTBI. We treated them with sleep hygiene counseling and oral prazosin. We monitored headache severity, daytime sleepiness using the Epworth Sleepiness Scale, cognitive performance using the Montreal Cognitive Assessment test, and the presence of NDs. We quantitatively measured olfaction and assessed PTSD severity using the PTSD Checklist-Military Version. Nine weeks after starting sleep counseling and bedtime prazosin, the veterans– headache severity decreased, cognitive function as assayed with a brief screening tool improved, and daytime sleepiness diminished. Six months after completing treatment, the veterans demonstrated additional improvement in headache severity and daytime sleepiness and their improvements in cognitive function persisted. There were no changes in the prevalence of NDs or olfaction scores. Clinical improvements correlated with reduced PTSD severity and daytime sleepiness. The data suggested that reduced clinical manifestations following mTBI correlated with PTSD severity and improvement in sleep, but not the presence of NDs or olfaction impairment.

Key words: combat, concussion, headache, mild traumatic brain injury, OIF/OEF, olfaction, pain, prazosin, PTSD, sleep.


View HTML  ¦  View PDF  ¦  Contents Vol. 49, No. 9
This article and any supplementary material should be cited as follows:
Ruff RL, Riechers RG 2nd, Wang X-F, Piero T, Ruff SS. For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement. J Rehabil Res Dev. 2012;49(9):1305–20.
http://dx.doi.org/10.1682/JRRD.2011.12.0251
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